What's New

The DMHC issued Frequently Asked Questions (FAQs) to clarify health plans must cover COVID-19 tests that are FDA approved or authorized, or approved by the state, without prior authorization and at no cost to the enrollee.

The Department of Managed Health Care (DMHC) is seeking a dynamic, creative, collaborative and consumer-oriented contracted Clinical Consultant to serve as the DMHC’s Chief Medical Officer (CMO). CMO will assist with ensuring health plan medical, behavioral health and administrative compliance with statutory and regulatory requirements in order to drive improvement in clinical outcomes for health plan enrollees and to improve the DMHC’s effectiveness.

For more information, please read this CMO Job Announcement. Interested candidates must submit required documents by June 30, 2020.

The DMHC issued an All Plan Letter (APL) in March directing health plans to ensure Californians can access necessary medical care through telehealth when medically appropriate. This includes directing health plans to reimburse providers for care provided through telehealth at the same rate as in-person care and ensuring enrollee cost-sharing is not changed for telehealth services. Following several questions from plans and providers, the DMHC issued All Plan Letter (APL) 20-013 - Billing for Telehealth Services; Telehealth for the Delivery of Services with a Frequently Asked Questions (FAQ) document. This includes information on provider billing during the COVID-19 State of Emergency to decrease administrative burdens on providers and plans.

As the state of California is taking action to respond to the COVID-19 pandemic, the Department of Managed Health Care (DMHC) joined with Covered California and the Department of Health Care Services to make sure Californians have a ready path to health care coverage.

The DMHC provided guidance to health plans on the special-enrollment period, including on and off-exchange health plans. This will ensure consumers enrolling in the entire individual market in California will have access to coverage during the pandemic emergency.

“We are working together to protect the health and safety of Californians during this pandemic,” said DMHC Director Shelley Rouillard. “This includes making sure that Californians are able to access health care coverage. Opening a special-enrollment period due to COVID-19 offers new coverage options to Californians when they need it most.”

The Department of Managed Health Care (DMHC) is seeking a dynamic, creative, collaborative and consumer-oriented contracted Clinical Consultant to serve as the DMHC’s Chief Medical Officer (CMO). The CMO will assist with ensuring health plan medical, behavioral health and administrative compliance with statutory and regulatory requirements in order to drive improvement in clinical outcomes for health plan enrollees and to improve the DMHC’s effectiveness.

For more information, please read this CMO Job Announcement. Interested candidates must submit required documents by May 8, 2020.

Under the direction of Governor Gavin Newsom, the Department of Managed Health Care (DMHC) issued an All Plan Letter directing all full-service commercial and Medi-Cal plans regulated by the Department to immediately reduce cost-sharing to zero for all medically necessary screening and testing for the novel coronavirus (COVID-19). This includes waiving cost-sharing for emergency room, urgent care or provider office visits when the purpose of the visit is to be screened and tested for COVID-19. The need for COVID-19 testing is based on medical necessity, a clinical determination made on a case by case basis by medical professionals.

The American Kidney Fund (AKF) has announced it is ending financial assistance funds for Californians in need. The following fact sheet includes information on alternative options patients can explore and how to get help with these other health coverage options.

The Department of Managed Health Care 2018 annual report and infographic are now available online. Both of these documents highlight the DMHC’s activities during 2018 and include key statistics about the Department.